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What is AERD/Samter’s Triad?

Aspirin tablet, 94084869Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.

What are the symptoms?

Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.

These reactions can include:

  • Increased nasal congestion or stuffiness
  • Eye watering or redness
  • Cough, wheezing, or chest tightness
  • Frontal headache or sensation of sinus pain
  • Flushing and/or a rash
  • Nausea and/or abdominal cramping
  • General feeling of malaise, sometimes accompanied by dizziness

If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.

Latest News & Information
13Jun 22

Dupilumab as an adjunct to surgery in patients with aspirin-exacerbated respiratory disease

We report a series of eight patients with AERD who had experienced a rapid recurrence of nasal polyps after a prior endoscopic sinus surgery, and who subsequently went on to have a revision endoscopic sinus surgery with perioperative initiation of dupilumab, a monoclonal antibody targeting interleukin 4Ra. We found that dupilumab led to no or slower nasal polyp recurrence after surgery compared to the prior sinus surgery, and perioperative initiation of dupilumab therapy also improved upper airway symptoms. This study provides evidence for the use of dupilumab as an adjunct to surgery to prevent polyp regrowth for patients with AERD and insufficient response to standard-of-care therapies. Read more here.

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15May 22

Dupilumab-associated arthralgia in patients with aspirin-exacerbated respiratory disease: a case series

We report a series of eight patients with AERD who developed arthralgias after initiating dupilumab. We found that 8 patients out of the 160 (5%) with AERD who have been prescribed dupilumab at our center developed possible dupilumab-associated arthralgias. Of the patients who underwent extensive rheumatologic work-up, no etiology of the joint symptoms was identified. All 8 patients experienced significant improvement in upper and lower respiratory tract symptoms and ultimately decided to continue dupilumab even with the possible dupilumab-associated arthralgias. Out of the eight subjects, the arthralgias spontaneously resolved in five of the patients. The cause of the dupilumab-associated arthralgias is unknown, but one possible explanation is a Type 1 or Type 3 “escape” with inhibition of IL-4Ra. Read more here.

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07Oct 21

Mepolizumab targets multiple immune cells in aspirin-exacerbated respiratory disease

Eosinophilic asthma and nasal polyposis are hallmarks of aspirin-exacerbated respiratory disease (AERD), and IL-5 inhibition has been shown to provide therapeutic benefit. However, IL-5Rα is expressed on many cells in addition to eosinophils, and the mechanisms by which IL-5 inhibition leads to clinical benefit in eosinophilic asthma and nasal polyposis are unlikely to be due exclusively to antieosinophil effects.

https://pubmed.ncbi.nlm.nih.gov/34144111/

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24May 21

COVID-19 in a series of patients with Aspirin-Exacerbated Respiratory Disease

A series of patients with AERD who developed COVID-19, including many who were treated with respiratory biologics for their baseline AERD, did not appear to experience increased morbidity compared to the general population with COVID19. This is reassuring to those with exacerbation-prone asthma and nasal polyps. It is intriguing that a strong type 2 inflammatory signal in the respiratory tract — a signal that the vast majority of patients with AERD exhibit — might actually be protective against severe COVID-19. Read more here.

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13Jun 22

Dupilumab-associated arthralgia in patients with aspirin-exacerbated respiratory disease: a case series

We report a series of eight patients with AERD who developed arthralgias after initiating dupilumab. We found that 8 patients out of the 160 (5%) with AERD who have been prescribed dupilumab at our center developed possible dupilumab-associated arthralgias. Of the patients who underwent extensive rheumatologic work-up, no etiology of the joint symptoms was identified. All 8 patients experienced significant improvement in upper and lower respiratory tract symptoms and ultimately decided to continue dupilumab even with the possible dupilumab-associated arthralgias. Out of the eight subjects, the arthralgias spontaneously resolved in five of the patients. The cause of the dupilumab-associated arthralgias is unknown, but one possible explanation is a Type 1 or Type 3 “escape” with inhibition of IL-4Ra. Read more here.

read more
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